MedPage Today spoke to several doctors about whether, and why or why not, they prescribed Afrezza.

Jennifer Holst, MD, University of Pittsburgh School of Medicine: "I did prescribe Afrezza to some patients. Inhaled insulin is a nice option for some patients with diabetes who prefer to inhale a medication than to inject. This is the second time that inhaled insulin has come out to market, and then been pulled off. Afrezza was much easier to use than the previous inhaled insulin."

Lee Green, MD, MPH, University of Michigan Health System: "I never did prescribe it; just didn't see a need for it."

Filip Knop, MD, PhD, University of Copenhagen: "I guess the well-established long-term safety of injected insulin outweighs the -- in my opinion -- questionable benefits of inhaled insulin. My patients with diabetes basically NEVER complain about insulin injections. The gauge of modern needles is so small that you basically can't feel the injection. Maybe needle-phobia is a problem among US patients, but -- really(!) -- it's not a problem that my patients mention very often -- despite my often asking them."

Howard Weintraub, MD, New York University Langone Medical Center: "I have not used inhaled insulin. I have been more comfortable with basal insulin preparations. This would not represent any major loss for me or any of my patients."

David Armstrong, MD, PhD, University of Arizona College of Medicine: "I know about this and it is an enormous shame. This is a drug with wonderful promise that will now not likely be realized. As a surgeon who specializes in preventing some of the end stage complications of this disease, I do not have occasion to prescribe it, but I do see the devastating results of diabetes and therefore am something of a customer myself!"

Joel Zonszein, MD, Albert Einstein College of Medicine: "I was perplexed when Sanofi made the decision to market it and I hope they've learn a lesson. As a clinician that treat individuals with diabetes I can attest that inhaled insulins, no matter how good ... have only a small place, if at all, in the current market.

"Inhaled insulins are not good for management of type 1 diabetes (where a basal and prandial regimens needs to be properly crafted for each patient by either multiple injections or CIIS pumps). Inhaled insulins are not good for T2DM as these patients need a basal regimen ... The pen syringes and needles used nowadays are excellent and almost painless -- thus, there is no need for inhaled insulins to replace these.

"Physicians often have a dark cloud in their mind with regards to large amounts of insulin in the lungs and if they can cause malignancy after years of use. There are also issues with the inhaled insulin as far as problems with the lungs, bronchitis, asthma, pulmonary function, etc."

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